Aortic root replacement with absent left-main coronary artery: How to do it

Prevalence of anomalous origin of right coronary artery (RCA) from left coronary sinus in population according to autopsy studies is 0.026%. Origin of left main coronary artery and RCA from opposite sinus of Valsalva with further course of anomalous vessels between aorta and pulmonary artery often is linked to sudden death. We present a case of anomalous origin of RCA from left coronary sinus and aneurysm of aortic root. Our case demonstrates that when both coronary arteries` ostia are close to each other coronary arteries can be re-implanted on common area. Firstly, this prevents distention and deformation of coronary arteries that might cause myocardial infarction. Secondly, it reduces time of placing anastomosis thus decreasing period of myocardial ischemia and cardiopulmonary bypass time.

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Acute Coronary Syndrome Caused by Left Main Coronary Artery Compression Between the Aortic Root and Massive Dilation of the Left Atrium

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2014.10.033 ◽

2015 ◽

Vol 31 (2) ◽

pp. 227.e3-227.e5

Author(s):

Bin Wang ◽

Yan Wang

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Left Atrium ◽

Aortic Root ◽

Left Main Coronary Artery ◽

Left Main ◽

Coronary Syndrome

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Successful Retrograde Visualization and Recanalization of Chronic Ostial Occlusion of the Left Main Coronary Artery via a Saphenous Vein Graft With the Drilled Balloon Technique

Clinical Medicine Insights Case Reports ◽

10.1177/1179547619852621 ◽

2019 ◽

Vol 12 ◽

pp. 117954761985262

Author(s):

Yakup Balaban ◽

Murat Güçlü Elevli

Keyword(s):

Coronary Artery ◽

Saphenous Vein ◽

Aortic Root ◽

Vein Graft ◽

Left Main Coronary Artery ◽

Saphenous Vein Graft ◽

Left Main ◽

Patent Graft ◽

Balloon Technique ◽

Ostial Lesion

We are representing a case of successful retrograde recanalization of a chronic ostial occlusive lesion of the left main coronary artery (LMCA) via a saphenous vein graft. A 70-year-old male patient, with a history of previous (3 years ago) coronary artery bypass surgery, was evaluated with coronary angiography because of his recent anginal symptoms. Left main coronary artery could not be visualized from the aortic root. It could be visualized with drilled balloon technique which was introduced retrogradely from a saphenous vein graft, and the chronic ostial lesion of the LMCA could be treated with balloon dilatation and stenting. Coronary occlusions can be treated retrogradely via the native collaterals and grafts. The coronaries that are not visualized with an antegrade fashion can be visualized with a retrograde way with the drilled balloon introduced through a patent graft. We could not find any publication about this technique on the web-based research. When encountered with a totally occluded ostial lesion of the LMCA, that cannot be visualized even from the aortic root, it may be tried to be visualized through a patent graft retrogradely. This is a safe and reliable method in patients with a total occlusion of the LMCA who also have a patent saphenous vein graft.

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